“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” – Dame Cicely Saunders, nurse, physician and writer, and founder of hospice movement (1918 – 2005).
Past vs Present
Dying—like being born—was generally a family, communal, and religious event, not a medical one. Not that long ago it was customary to dye at home, surrounded by family and friends, with familiar sounds and smells coming from a place of comfort, our sanctuary. After the second world war the act of dying made a drastic transformation to dying in the intensive care units all across the globe. The location where death typically occurs has also changed, moving from the home, to technologically sophisticated and often impersonal settings.
We live almost twice as long as we did only less than 200 year ago. Sudden death is not as common as it once, it has been replaced by long periods of chronic illness as the end of our lives. In the past two decades, there has been an increased demand by individuals and families for active participation in medical decision-making. We are seeing changes in public attitudes about participation in medical decision-making. Seeking help from mental health professionals changes in expectations about end-of-life care.
Money vs Time
It has been estimated that in the United States nearly 60 percent of all deaths occur in hospitals or medical centers. Another 16 percent occur in other institutions, such as nursing homes or hospices. Cost are high for those people who die in the hospital, increase come sometimes in unnecessary testing and procedures. Studies show patients who died at home at a cost of about $4,760 for their last month of life, one month in a hospital at a cost of $32,379. Only a minority of people die in the care of formal hospice programs, and the majority of these hospice deaths involve cancer diagnoses. More recently, the proportion of those who die at home has begun to increase because changes in Medicare benefits have led to increased availability of home hospice services. The average cost to medicare for a patients last two months of life cost medicare $50 billion last year. When asked, 72% of patients report they would rather stop treatment if given that option.
Living means MORE than just staying alive and we have to talk about it.